Discharge from Hospital help please.(10 Posts)
Mum has been in hospital for 11 days after a bout of pneumonia with some complications with heart failure and COPD. Just a week ago, they told us that she was close to dying. She's picked up a little, but is not anywhere near her former self yet. They were talking about her condition and saying that there was not much hope she would see more than 12 months at most with her current condition.
The hospital are starting to talk about discharging her to her home, despite the fact that she needs constant oxygen at the moment, cannot get into bed without help and can only manage to go to the toilet and back with great difficulty.
I'm very concerned that they are going to discharge her when she needs a huge amount of care. I haven't seen a care plan, or even heard talk of one. What questions should I be asking of them, and who should I be asking? Can I refuse to let her be discharged if I don't think she can cope or that we have the right support in place?
Whilst I am happy to do some of the caring, I work, have a family and have a dodgy back, so can't do heavy lifting etc.
It's been a bit of an emotional week, and not a great start to a new year, but I am trying to stay calmish and try and get things in to place for her.
Thanks for any advice you have x
Op you are in a difficult situation here and need to ensure that your DM has a planned discharge with all her needs assessed and care put in place prior to discharge home. This is easier said than done IME.
Firstly, and you nned to be firm here, DO NOT allow yourself to be put into a position of taking on more care than you can reasonably give. Do not feel guilty about this. IME some hospitals are very quick to say people are 'medically fit for discharge' - that does not mean they can just expect you to take your Mum home if she cannot be safely cared for there.
The hospital should be assessing her needs in multidisciplinary team approach. doctors, senior nursing staff, Occupational and Physiotherapy and social worker. Ask for an appointment to discuss her needs with the senior nurse in charge of hers care.
Are you her only child, have you siblings who need to be included in future care of you Mum? Is is eligible for NHS Continuing Care funding? Does she need some 'convalescence in a nursing home prior to going home? Is her home suitable? What adaptations are needed? Bed downstairs, bathroom or washing facilities, toilet, oxygen supply, meals, cleaning, carers/domestic help, security, falls prevention, emergency alarms systems, psychological care and companionship.
Age UK has helpful information on their website and advice line, and there may be local agencies that can offer help, visiting etc but it varies from area to area.
Have a look on previous posts on the Elderly care and the Life limiting illness topics.
Hopefully others with experience will be along on this thread with advice.
I'm sorry your mum has been so ill. One of the things I've found is that while your mum is in hospital peoples minds are more concentrated on organising care than once they are at home.
Now is the time to get in contact with the ward social worker and make it very clear what the situation is for your mum. Alas, its better to say you cannot care for her, and then be able to do all the bits carers won't, than to say you can do some and end up burning yourself out.
And if you don't think the right care package is in place, then do say that you think it places her at risk and you do not agree with discharge. And never accept discharge on Fridays or weekends because then if things aren't in place you have no chance of sorting it.
Write down all conversations with who said what and when so you can refer to it if necessary
Thanks, I visited tonight but there was none around to talk to shop I will phone and make an appointment tomorrow. I asked Mum what she thought and she doesn't feel like she will be ready so I told her to tell them that she had no care in place and to ask for a care plan before any discharge can be arranged. I have siblings but neither really in a position to offer full time care. Difficult to know what to do until she is ready to come out but I think we need a lot of adaptations and extra help. Will start making plans. Thanks for the support. X
Hi OP I don't post here much but have been through similar with MIL recently- there MUST be a care plan in place before discharge. Speak to the discharge co-ordinator and social services if you can, an assessment will need to be made.
MIL was living with us prior to an operation which she reacted badly to, we knew we would not be able to cope at home so in the end to break the deadlock moved her into a care home for 4 weeks convalescence. This may not be an option for you as it is expensive but worth looking into. MIL came home to us but is sadly back in care again (but that's a whole other thread..)
It really is a mine field, good luck!
Thanks, we asked for a written care plan, at which point we were suddenly reassured that she wouldn't be discharged before she was ready. Then, they announced aday later that she would need oxygen installed at home. We haven't seen a care plan, they are organising OT assessments but also doing more investigations. So hard to plan anything at all until we know what she needs. Is even harder for her though as I know she just wants to go home...
I know that my work will be tricky about time off which makes me more stressed.
I think we will organise things better when we know a date for discharge and hopefully what she needs.
So there are a number of different options. She will have seen a physio at some point, who will assess her level of mobility and whether or not she can manage stairs. If she is struggling to get in and out of bed/chair then she'd well all see an occupational therapist. The nursing staff will be adding how she is managing personal care(washing and toileting) and feeding back to OT. Ward nursing staff need to raise a section 2 (or IHSC -integrated Health and Social Care Team) assessment. The culmination of all the assessments will influence what happens next. If it is felt that she is likely to have rehabilitation goals (ie she is likely to regain some or all of her independence) then she would be funded by health in either a community rehab bed or supported with rehab at home. If she's likely to leave hospital with requiring support with personal care, then ss will need to provide a care package, as long as she doesn't have over a certain amount in savings- there is a threshold over which care will be self-funded. It is a bit of a dream out process as patients have to be medically fit for discharge before ss get involved, but keep talking to the nurses about what is happening.
I would insist on a social work assessment before she is discharged from hospital.
As a PP poster has said she should have been seen by physio and occupational therapy who will be providing ongoing support in hospital and making recommendations for home. In our hospital we have a bathroom, kitchen and bedroom where the OT takes them to practice different things like making tea, getting dressed, in and out the bath. The OT can also organise a pendent alarm if you feel she is at risk of falls and would feel secure with this.
Where I work it's very easy to set up a package of care, it takes 15 min to phone through and can be started as soon as 24 hours later.
The home oxygen is down to (where I work) the medical staff and respiratory specialist nurses to organise.
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